Utilization Management Nurse - Albany Medical Center : Job Details

Albany Medical Center is seeking a dedicated Utilization Management Nurse to join our Care Management/Social Work team in Spencertown, NY. This is an exciting opportunity for a nursing professional to make a significant impact in patient care and resource management.

Key Responsibilities:

• Conduct Utilization Management and Quality Screenings for assigned patients.
• Apply MCG criteria to ensure appropriateness of admissions and continued stays, documenting findings according to departmental standards.
• Identify opportunities for clinical documentation improvement and collaborate with the necessary departments to enhance practices.
• Utilize approved screening tools to identify at-risk populations, adhering to established reporting procedures.
• Monitor length of stay (LOS) and resource utilization continuously, implementing strategies for ongoing improvement.
• Refer cases to the Medical Director and Triad Team as per departmental protocols, ensuring follow-up as necessary.
• Communicate covered day reimbursement certifications for assigned patients effectively.
• Address payor criteria issues with clinical staff on a case-by-case basis, ensuring resolutions are achieved.
• Utilize quality screens to pinpoint potential issues and relay findings to the Quality Department promptly.
• Foster communication among the health care team and collaborate across the continuum of care to enhance patient management.

This role may require access to sensitive information, including HIPAA Protected Health Information. As a workforce member, it is crucial to ensure compliance with Albany Medical Center's policies, maintaining the confidentiality and security of all patient information accessed.

Albany Medical Center is an equal opportunity employer, committed to diversity and inclusion in the workplace. Thank you for your interest in joining our team!